When a person has both an alcohol/drug problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis.

According to SAMHSA's 2014 National Survey on Drug Use and Health, an estimated 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness. In the past year, 20.2 million adults (8.4%) had a substance use disorder. Of these, 7.9 million people had both a mental disorder and substance use disorder.

"In a dual diagnosis, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of one's ability to function, handle life's difficulties, and relate to others," explains Gus Stieber Director of Clinical Outreach Services for Kiva Recovery, a substance abuse treatment and recovery center in Vernon Hills. "To make the situation more challenging, the co-occurring disorders also affect each other and interact. When a mental health problem goes untreated, the addiction problem usually gets worse as well. And when alcohol or drug abuse increases, mental health problems usually increase too."

Although substance abuse and mental health disorders are closely linked, the National Council on Alcoholism and Drug Dependence contends that one does not directly cause the other.

* Alcohol or drugs are often used to self-medicate the symptoms of depression or anxiety. Unfortunately, substance abuse causes side effects and in the long run worsens the very symptoms they initially numbed or relieved.

* Alcohol and drug misuse can increase underlying risk for mental disorders. Mental disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental disorder, drug or alcohol abuse may push you over the edge.

* Alcohol and drug misuse can make symptoms of a mental health problem worse. Using drugs or alcohol may sharply increase symptoms of mental illness or trigger new symptoms. Alcohol and drugs also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective.

Let's take a closer look at alcoholism as there appears to be a particularly strong correlation between that and depression. A study of 200 male alcoholics admitted into a treatment center showed that a staggering 43% met the criteria for clinical depression. Many of these alcoholics developed depression after they began drinking. While there are multiple theories about why this happens, it's important to understand that when the alcoholic stops drinking for about a year their reported levels of depression decrease. Over half the people in the study who qualified as clinically depressed reported minimal levels of depression after a year of being sober.

While there is no consensus on whether mental illness causes alcoholism or vice versa, we do know that when a person is suffering from a mental health disorder, they often experience feelings of hopelessness, depression, anger, or impulsiveness. Because of this, they find themselves feeling lost and often turn to alcohol (and other substances) to self-medicate. Alcohol may temporarily numb the symptoms, but when someone uses alcohol to self-medicate they are more likely to become dependent upon alcohol than an individual who consumes alcohol without having a mental disorder. In turn, they may eventually develop an alcohol addiction, a serious problem in itself, which combines with the effects of the untreated mental health disorder. In fact, those with mental disorders are thought to be around 50% more susceptible to addiction.

We also know that those who suffer from alcoholism in combination with a mental health disorder may have a more difficult time getting sober than others who abuse alcohol, as they feel that they need alcohol to fight the symptoms of the mental disorder. As the two conditions influence and mimic one another, a person may seem to have a mental illness when the symptoms are actually caused by alcohol abuse or vice versa. In instances where the mental disorder goes undiagnosed and alcoholism is treated, the individual will still experience symptoms after alcohol use has ceased. This makes individuals more likely to go back to alcohol, and the cycle of alcoholism continues.

Whichever came first - the chicken or the egg - it's important to understand that treating substance abuse without proper attention to underlying mental health concerns is like treating the pain that stems from an infection but not the infection itself. But, with proper treatment, support, and self-help strategies, one can overcome a dual diagnosis and reclaim their life.

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